Chemotherapy

Chemotherapy consists of drugs (individually or in cocktails) designed to kill tumor cells.  Chemotherapy can be intravenous and/or pills.  Chemotherapy is used when solid organ tumors have spread to distant organs (Stage 4), to treat solid organ tumors before (neoadjuvant) or after (adjuvant) surgery, and in hematologic “liquid” tumors (i.e. leukemia, lymphoma, multiple myeloma).  Chemotherapy and radiation can be combined together to increase the potency of radiation or used sequentially.

Most of the “old” stereotypes of cancer patients just nauseous or vomiting their whole treatment course can be avoided with modern anti naseau medications (unfortunately, there are still a minority of patients with persistent nausea issues  despite medications).  However, chemotherapy can to be quite a tough cocktail of drugs, but the experience of any patient is based on the specific drugs that are chosen as well as patient and disease related factors.  For example, patients receiving induction chemotherapy for acute myelogenous leukemia (AML) will spend a substantial amount of time in the hospital during the first round of chemotherapy in which they will experience fatigue, loss of hair, low blood cell counts, and need multiple transfusions and be at risk of infection.  On the opposite end of the spectrum, patients receiving maintenance therapy for indolent lymphoma will come about every 3 to 6 months to receive an antibody which will have almost no side effects.

The following slides are ones from a lecture I put together to describe the differences between “traditional” and “targeted” chemotherapy drugs:

An example of "traditional" chemotherapy with one of our oldest drugs

The 2 major classes of "Targeted" chemotherapy. Biologic antibodies are very complex molecules (more so than small molecule inhibitors) and are harder to manufacture.

Targeted chemotherapy: Antibodies target the "outside" of the cell (also they are too big to get into the cell), Small molecules target the "inside"

Differences between Traditional and Targeted Chemotherapy

Differences between Traditional and Targeted chemotherapy

Note that while “targeted” agents sound cooler than “traditional” chemo drugs, “targeted” agents still have side effects because the pathways they operate on are in both normal cells and tumor cells.

Traditional Chemotherapy Drugs

  • 5-Fluorouracil (5-FU)
  • 6-Mercaptopurine (6-MP)
  • 6-Thioguanine (6-TG)
  • Abraxane
  • Actinomycin-D
  • Arsenic
  • Asparaginase
  • BCNU
  • Bleomycin
  • Busulfan
  • Capecitabine (Xeloda)
  • Carboplatin
  • Carmustine
  • CCNU
  • Chlorambucil
  • Cisplatin
  • Cladribine
  • Cyclophosphamide (Cytoxan)
  • Cytarabine
  • Dacarbazine
  • Daunorubicin
  • Docetaxel (Taxotere)
  • Doxil
  • Doxorubicin (Adriamycin)
  • Epirubicin
  • Etoposide
  • Fludarabine
  • Gemcitabine (Gemzar)
  • Hydroxyurea (Hydrea)
  • Idarubicin
  • Ifosfamide
  • Irinotecan (CPT-11) (Camptosar)
  • Lomustine
  • Mechlorethamine
  • Melphalan
  • Methotrexate
  • Mitomycin-C
  • Mitoxantrone (Novantrone)
  • Oxaliplatin
  • Paclitaxel (Taxol)
  • Pemetrexed (Alimta)
  • Pentostatin
  • Procarbazine
  • Streptozocin
  • Temozolomide (Temodar)
  • Thiotepa
  • Topotecan (Hycamtin)
  • Vinblastine
  • Vincristine
  • Vinorelbine (Navelbine)
  • VP-16 (Etoposide)

Targeted Chemotherapy Drugs – Antibodies

  • Alemtuzumab (Campath)
  • Trastuzumab (Herceptin)
  • Rituximab (Rituxan)
  • Panitumumab (Vectibix)
  • Vorinostat (Zolinza)
  • Zevalin
  • Ontak
  • Cetuximab (Erbitux)
  • Bevacizumab (Avastin)
  • Bexxar

Targeted Chemotherapy Drugs – Small Molecule inhibitors

  • 5-Azacitidine (Vidaza)
  • Thalidomide
  • Targretin
  • Tarceva
  • Sorafenib (Nexavar)
  • Sunitinib
  • Dasatinib (Sprycel)
  • Lenalidomide (Revlimid)
  • Imatinib (Gleevec)
  • Lapatinib
  • Nilotinib Tasigna
  • Decitabine (Dacogen)
  • Bortezomib (Velcade)
  • Azacitidine (Vidaza)

Also note that hormonal agents used in the treatment of prostate and breast cancer and carcinoid are not listed here.

 






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